Applying for Grants to Support Rural Health Projects

Rural America includes vibrant communities that find innovative solutions to unique health challenges.
Nonprofit organizations and healthcare providers in rural areas rely on government and state funders as well as
foundations to help bring new projects to life or sustain crucial, existing services.

Getting a grant is hard work, and can involve numerous, time-intensive steps. Funders hold competitive cycles
for grant programs in which rural organizations must compete alongside well-funded, well-prepared organizations
with dedicated and experienced grant writing teams. Organizations in rural areas are less likely to have staff
members strictly dedicated to grant writing. Community members or staff members who have the most writing or
business experience may be chosen by necessity to be responsible for securing funds.

Lack of major foundations located in rural areas, leading to fewer networking opportunities

The inability to show potential impact to funders when serving less densely populated areas

Perception that rural projects are less sustainable and organized

Smaller local nonprofit infrastructure

In addition to those barriers, the amount of funding being allocated to rural organizations is significantly
smaller per capita when compared to urban counterparts. A 2015 USDA report, Foundation
Grants to Rural Areas from 2005 to
2010: Trends and Patterns, compares the average value of grants from large foundations given from 2005
to 2010. The report states that organizations based in nonmetro counties received less than half the amount per
capita compared to organizations in metro counties.

The purpose of a grant proposal isn't just to request funding. Successful grant applications should be thought
of
as one of the first steps to building sustainable, long-term programs that will increase the health of rural
communities. This guide can serve as a starting point for those who need assistance to begin the grant writing
process. It will cover tips on searching for rural-specific funding, grant proposal preparation, building
successful funding relationships, and planning for program sustainability.

Related Toolkit

The Rural Philanthropy Toolkit provides a wealth of information
about philanthropy and how foundations and rural communities are working together to build capacity,
support economic development, increase access to healthcare, and provide much needed wrap-around
services.

How can I learn about funding opportunities for rural health-related organizations?

Here at the RHIhub, we offer many ways to learn about funding opportunities. The RHIhub Funding
and Opportunities section includes federal, state, local, and private funding programs of interest to
rural health organizations and rural organizations interested in the social determinants of health. RHIhub staff
reviews funding and opportunities that are added to the database,
making certain that all of the funders either expressly state they will fund in rural areas, or have been known
to fund in rural areas in the past.

RHIhub can also conduct a free, customized funding search on your behalf, which will identify funders who may be
interested in your project or program. Contact us at 800-270-1898 or info@ruralhealthinfo.org
to request a custom search. Please include your zip code and the purpose of your project in your request.

To stay up-to-date on the latest funding opportunity announcements, subscribe to the RHIhub
This Week newsletter or to one of our RSS feeds.

Other ways to find federal agencies and other funders who fund rural projects (please note that RHIhub
staff
search these sources for relevant information on a daily basis):

Grants.gov –
Serves as a comprehensive
website with information about finding and applying for all federal grant programs, including funding from
the Federal Office of Rural Health Policy, USDA Rural Development, and other federal agencies who provide
opportunities related to rural health.

Federal
Register – Provides access to information
about federal benefits and opportunities for funding. There will be information overlap with funding
sources provided on Grants.gov.

The
Foundation Center – A nonprofit organization
that provides information, resources, and training related to working with philanthropic organizations.

Foundation
Directory
Online – A subscription-based service that collects
and organizes information about philanthropic organizations in the United States. Has a searchable
database of known funders.

Philanthropy
News Digest –
The daily news service of the Foundation Center. Publishes philanthropy-related articles and open
requests for proposals.

Funding
Information Network Locations – Free funding information centers that provide a
core
collection of Foundation Center publications and a variety of supplementary materials and services.
Staff are available to assist you with funding searches at each location.

State Offices of Rural Health – Many SORHs administer funding programs, and most are
knowledgeable about the funders operating within their state. Many have websites or electronic newsletters
that include funding and opportunities. Contact your State
Office of Rural Health to learn how to find funding information specific to your state.

Other sources to consider:

Businesses and organizations operating in your area – Corporations, banks, and other
local
businesses often fund projects that will benefit the areas in which they operate. Especially if you are
looking for a small amount, these organizations can be valuable sources of funding.

Community foundations – Many rural areas have community foundations who look for
local
projects to fund. To find your nearest Community Foundation, you can use the Council on Foundations' Community
Foundation Locator.

Civic organizations – American Legions, Chambers of Commerce, Rotary Clubs, and the
like may
have small amounts of funding available, or may consider hosting a fundraiser on behalf of your
organization.

I found a grant program that looks like it would work for my rural project. Should I call first or just send in
a proposal?

Making contact with funders before submitting a proposal is almost always a good idea, but it varies by funder.
Carefully review the funder's giving priorities to make sure your project matches up, and then look through what
funders have to say about contact. Some funders make it explicitly clear that they aren't interested in
discussing applications while others expressly ask applicants to talk to a program officer prior to
submission. It is important to note that while federal program officers can answer technical questions about
funding opportunities, they are unable to provide feedback to strengthen an application.

Unless otherwise noted, speaking with a program officer about your application before submission can only
strengthen it. When you reach out to a funder, be prepared to answer basic questions about your project, such as
overall concept, budgetary needs, and partners who may also be involved. Program officers know what types of
projects will be competitive and may be able to help hone your request.

Does my organization need to be a nonprofit to apply for grants?

Typically, yes. Funders rarely make grants to for-profit businesses. Grant funds are almost exclusively reserved
for nonprofit organizations with 501(c)(3) status, with exceptions made for tribal, governmental, and civic
organizations. It is important to read through the program guidance closely to determine eligibility. There are
some exceptions. For example, the Federal Office of Rural Health Policy’s network-based grant programs allow a
network member to be a for-profit entity, as long as the lead applicant is a nonprofit.

What do I need to consider before applying for a grant?

It's important to note that grants should not be considered as the first place to start. Resources can be
gained through partnerships, sub-contracting, and local fundraising strategies. Grantseeking should come only
after significant program development thinking.

A grant is not a gift or charity; rather, a grant is an exchange relationship between a funder that wants to
address a problem and an applicant who also wants to address a problem. When a funder awards a grant, it is
making an investment towards meeting its own mission. Therefore, funders want to invest in organizations that
operate in a manner to address their mission and have a track record for meeting goals and objectives. Consider
what you bring to the table — your history, your successes, your credibility, what you can offer. It is
not just what the funder does for you, but what you can do for the funder. It is okay to brag a little, as you
have to give the funder a reason to invest in you to help address their mission.

Most federal agencies and foundations want to fund organizations that are legally organized, have a mission
statement, an annual budget, support from their local communities, and documented community impacts. Many
funders require that applicants be incorporated for a period of time before they are even eligible to apply for
a grant.

Create one-page concept papers for each of your projects. It helps to have project ideas ready so you have
talking points if you get an audience with a potential funder.

When thinking about a potential project, seek out and involve partners from other agencies from the very
beginning. Consider how you might pool resources in order to create a more effective project. More and more
funders are looking favorably upon grant applications that include a consortium of community organizations
working together. Evidence has shown that collaboration reduces overlap and leads to bigger impact.

Get to know the people at local community foundations well before any grantseeking. Community foundations
are in tune to the local philanthropy landscape. They can perhaps help develop donor advised funds in your
interest area, or in the very least help you come up with places to look for funding.

Take a look at a potential funders' websites, annual reports, and IRS PF990 forms. These items will
give great insight into what is important to them.

The grant guidance says we need to be rural. What does that mean?

Rural is an inexact term that can mean different things to different people, organizations, and government
agencies. RHIhub offers the Am I Rural? tool to help determine whether a specific
location is considered rural based on various definitions, including those used by federal grant programs.

Federal agencies make reference to many acronyms and codes to represent statistical areas across the country. In
federal grant announcements, one may see “RUCA” for Rural-Urban Commuting Areas, “HPSA”
for Health Professional Shortage Areas, or “MUA” for Medically Underserved Areas. For more
information on navigating commonly used acronyms and rural definitions, see RHIhub's What is Rural? topic guide.

Does our organization need to hire a grant writing consultant?

It depends on your organization's staffing level and expertise. It can take an estimated 200 hours for a first
time federal grant application. If there is an
individual or group on staff who
can complete the proposal adequately and in time for the application deadline, you may not need a consultant.
Consider the skills of staff and volunteers, and build grant writing teams. If
your organization lacks the expertise to develop one particular aspect of the proposal, such as the budget, you
may want to hire a consultant just for that section. Or you may choose to have a professional grant writer
prepare the entire proposal.

If this is the first grant proposal your organization has submitted, a grant consultant may be able to guide you
through the process and lend you valuable expertise. Grant writers can be very helpful, but they don't know the
work like you do. Wait to engage a grant writer after you have done the preliminary work yourself. As stated
earlier, grantseeking should only come after significant program development thinking.

It is a best practice to have basic proposals and projects already developed in anticipation of grant
opportunities. If you wait for a grant announcement, you may not have enough time! While all grant programs have
different review criteria, most request similar types of information. Doing initial thinking and writing around
those common information requests will make the process for preparing individual grant applications easier. If
the information is already organized into electronic folders, then boilerplate text can be dropped into
proposals and edited.

If you decide to work with a grant writer, you should be able to re-use many of the sections listed above in
future proposals, furthering the value of the consultant's fee.

Before hiring a consultant, take some time to get acquainted with the ethics and standards of fundraising. The
National Council of Nonprofits has several resources on ethical
fundraising.
The Association of Fundraising Professionals maintains a Code
of Ethical Standards
involving transparency, stewardship, confidentiality, and compensation; these standards can provide a framework
for developing a contract with a consultant.

Whether the proposal is written by staff or a consultant, everyone involved with implementing the proposed
project should familiarize themselves with the workplan, application, and program requirements. If the grant
application is successful, then everyone has a good understanding of the program expectations.

If you decide not to hire a consultant:

Ensure you thoroughly read through the instructions and guidance and follow the directions down to the
smallest detail. For instance, many applications require that certain font styles and font sizes be used.
Many applications list the order that they want the grant application information to appear, have page
limits for each section, or require the use of very specific language. Federal grant reviewers have shared
that often as many as 1/3 of all grant applications are disqualified simply because the applicants did not
follow directions.

Have strong writers/editors on the team review all the materials before submission to ensure the information
from each section correlates well to the other sections of the application. Allow plenty of time for
proofreading and editing and getting any required supervisors to sign off on the application prior to the
deadline.

There are several organizations that may provide technical assistance for rural organizations seeking grants.
All states have a designated State Office of Rural
Health, and many SORHs will provide grant writing training, guidance during the writing process, or
review and critique of completed grant proposals. Likewise, many State Rural Health Associations provide
training programs and technical assistance for grant writers working with rural health organizations.

Primary Care Associations are state or regional nonprofit organizations that provide training and technical
assistance for safety-net providers. Primary Care Associations may provide informal grant writing assistance,
especially for agencies applying for HRSA Health Center funding. HRSA maintains a
map of state
and regional Primary Care Associations on its website.

Many large foundations and federal agencies hold conference calls and technical assistance webinars ahead of the
application deadline to provide an overview of the application process and allow time for questions. The
information for the technical assistance events is typically included in the grant guidance.

Grant applicants can contact their HRSA
Office of Regional Operations representative to ask about the availability of grant writing assistance.
The Office of Regional Operations hosts webinars and trainings on applying for HRSA grants, and they may be
contacted to ask about upcoming trainings and additional webinar recordings.

The funder says we need to use an evidence-based model for our program. Where can I find rural
evidence-based project examples?

Evidence-based can mean a variety of different things to different funders, so it is important to clarify what
the funder's requirements are regarding level of evidence.

The RHIhub offers the Rural Models and Innovations section,
which is a valuable source of rural-specific project examples. These models are regularly updated to reflect the
latest project outcomes and are sortable by evidence level, state, topic, and funding source. Each model
includes a contact who can answer questions about the program. Successful rural models are categorized based on
four levels of evidence:

Evidence-based – Tried in numerous rural locations, a review study published in a
peer-reviewed journal, overall results were generally positive.

Effective – Tried in single rural location, positive results published in a
peer-reviewed journal.

Promising – A formal program evaluation showed positive results.

Emerging – Anecdotal account of a successful rural program.

The County Health
Rankings Action Center is another place to search for examples of evidence-based work. In addition, you
may be able to find successful evidence-based programs by browsing through a funder's list of past projects.
Most funders will detail their most successful programs through news articles, reports, or in program summaries
on their websites. A successful strategy can be to put together a hybrid project using parts of multiple
evidence-based programs that would be applicable in your area.

Sometimes there is just no rural-specific evidence base for a particular project. In that case, many funders
will allow grantees to adapt evidence-based models for their rural area and target audience. Be sure to discuss
this with the potential funder if evidence is unavailable.

How do we show that our project addresses a real need?

Write a well-thought-out narrative that focuses on how the project will help the community and includes relevant
statistics and data to support your case. This is your chance to educate the funder about your community and
about the people you are trying to help. When possible, use tables or graphics to show comparisons of local,
state, and national data. The grant reviewers who are making decisions about your grant proposal
may come from completely different backgrounds, and may not be familiar with the specific problems faced in your
community, or rural areas in general.

A common weakness in grant applications is not adequately connecting the needs section with the program
description, methodology, and work plan. Many grant applications will have a vast array of demographic
information listed in the needs section, but do little to substantiate the need as it relates to the solution or
program. Be sure that any data provided in the needs section is addressed when describing the project and
services.

How can I find supporting statistics or research for rural health grant proposals?

A good way to demonstrate need is to compare data for the proposed service area to state and national data.
RHIhub offers the Finding Statistics and Data Related to Rural
Health topic guide. The guide covers frequently asked questions about locating rural health data and
statistics that can be used to support grant proposals and communicate your community's needs effectively to a
funder.

Are maps useful to include in our grant application?

Maps can be an effective way to illustrate arguments made in your grant application and will provide visual
emphasis to written problems.

Maps may be used to show:

Demographics

Health status

The location of healthcare facilities

The distribution of healthcare workforce

Data related to specific population groups

Information about transportation and access to healthcare

Maps can be used in proposals to show grant reviewers visual locations and distances within the state. Many
grant
reviewers may not know your community or your location within the state. Be careful that maps don't take up too
much space and that they are readable if printed in black-and-white.

RHIhub's Rural Data Visualizations section houses a collection of charts, graphs,
and interactive maps that explore data down to the county level on issues that impact rural health, including
rural demographics, health disparities, the health workforce, and other topics. Static maps showing the
locations of rural healthcare facilities in each state are also available.

When a funding opportunity requires matching funds, what are some strategies to come up with the match?

Matching funds, sometimes called cost-sharing, is when the costs of a project are shared between the parties
involved. If expected, cost sharing/matching requirements will be outlined in the grant guidance.

Cash Matches

There are many different options for procuring cash matches. Community foundations, local businesses, and
community-based organizations all may be good sources of funding for matching grants. It is important to
identify these stakeholders early in your process and explain clearly how their contributions could be used to
leverage additional dollars for the community.

The Council on Foundations Community
Foundation
Locator tool can help to identify if your community has an established Community Foundation.

In-kind Matches

If an in-kind match is acceptable to the funder, there are many ways to show the contribution your organization
and community are making to the project:

An organization can provide a cash match.

Staff time and volunteer time can count as an in-kind match. Track the contribution that participants'
organizations are providing by allowing them to work on the project, including their attendance at meetings.

Construction and donations of capital equipment or supplies may be used as an in-kind match.

You may also want to keep track of other types of in-kind contributions, such as space, equipment use,
printing, mailing, or utility costs.

It is important to document everything and keep good records of in-kind matches. It is also important to note
that most federal grant programs refer to matching as cost-sharing, and one cannot use federal dollars
to
match other federal dollars.

Should we try to find a single funder or should we use multiple funding sources?

While it would be ideal to find a single source of funding for a major project, many small organizations rely on
multiple funding streams to support their work. Don't discount the smaller chunks of money that are available
from funders in your area. If you add up several small grants, you may find you have enough money to do what you
set out to do. Many funders recognize a great benefit to having program investment from multiple funding groups.

Additionally, diversifying the source of your organization's funding can make your project or organization more
financially secure and sustainable in the event that one source of funding is lost.

This is where a development consultant, sometimes known as a fundraising consultant, may be useful. Development
consultants can assist with program development, as well as the development of fundraising and sustainability
plans for projects and services. Typically, fundraising plans will involve activities in addition to grant
writing, such as individual giving, capital campaigns, and local fundraisers.

Organizations that do not have the resources to hire a development consultant may still benefit from fundraising
planning. Grant Space offers a free course, called Introduction to
Fundraising Planning, that is provided through in-person, live webinar, and on-demand formats.

What can we do to make our rural project more sustainable?

Funders are increasingly looking to proposed plans for sustainability during their decision-making processes.
Most funders want to know that the dollars they are giving will lead to lasting impact and change. Therefore,
planning for sustainability from the beginning of your project is extremely important.

The Rural Health Information Hub offers Sustainability Planning Tools. The
tools were developed by the Georgia Health Policy Center for the Federal Office of Rural Health Policy's
community-based grantees. They are also useful for programs funded by other sources. The tools are intended to
help you consider the sustainability of programs that address community needs and engage partners and
stakeholders in this planning process.

How do we create an evaluation plan to include in our grant proposal?

Funders typically place significant emphasis on your plan to evaluate your project. Tracking and reporting on
processes and outcomes will help your project improve processes, be accountable to the funder, and show impact.
Evaluation planning should be done as part of the initial program design to ensure that program elements can be
adequately evaluated, that benchmark data are available, and that opportunities for performance improvement are
included in the program design.

The question commonly comes up, Does an outside evaluator need to be hired as part of our grant project?
Most grant programs do not require outside evaluation at the local program level. Typically, a well-thought-out
evaluation plan is sufficient. Specific language will be in the application guidance if budget funding needs to
be allocated for a contract with an outside evaluator.

A term you may see when talking about workplans and program evaluation is logic models. A logic model
presents a visual image of how your initiative is supposed to work and offers a logical explanation of how your
strategy is a good solution to the problem at hand. Logic models can be a helpful planning tool, especially when
writing grant applications. Many funders, especially federal agencies, request logic models as part of the
application. Even in cases where a logic model is not required as part of the application, creating a logic
model can be helpful in developing a project framework and workplan. The Kellogg Foundation offers many
resources on evaluation, including the Logic
Model Development Guide. Similar terms you may see in application guidance instead of logic model
are conceptual map, framework, blueprint, chain of causation, and theory of change.

How important is networking and collaborating to getting a project funded?

It can be very helpful to network with other facilities, agencies, and organizations in your community and
beyond. It is important to build your credibility and reputation so that funders are aware of the good work you
do and think of
you when they have extra funds to allocate. Colleagues at other nonprofits may share information on funding
opportunities with you. They may also be willing to act as grant writing partners or mentors.

Networking can:

Reduce the cost of grant writing

Increase capacity to carry out programming

Expand programs and services to enhance the reach and effectiveness of projects

Increase chances of getting funded, when partnerships lend their good reputation

In some grant programs, including many of the funding opportunities through the Federal Office of Rural Health
Policy, networking or collaborating with other organizations is a requirement to receive
funding. Many funders want to know that a project or program has broad support across a variety of different
spectrums. In other grant programs, extra points are awarded for networking with other organizations.

How do I apply for a federal grant that requires electronic submission?

Most federal agencies require that grant applications be submitted electronically through Grants.gov.

Grants.gov
requires a one-time registration by the applicant organization. To begin the registration process, follow the
steps outlined on Grants.gov:
Organization Registration. This is a time consuming process that requires financial information, a DUNS
number, as well as registration with the System for Award Management (SAM). SAM has new registration
requirements as of July 2018. HRSA states on
their website that the process of registering in all three of these systems (Grants.gov, SAM, and DUNS) can take
up to a month to complete. It is recommended to go through this process right away even if you aren't currently
applying for a grant.

Be sure to renew
your registration every year. The renewal process can take
48-72 hours to validate, and you will be unable to submit an application if your account is inactive.

Where can I find examples of successful grant proposals?

There are many ways to access copies of successful proposals.

Many funders provide copies of successful proposals and/or detailed project summaries on their program
websites. If you are unable to locate this information, you can always reach out to the funder to ask if
they have examples of previous proposals.

For federal proposals, you can make a Freedom of Information Act (FOIA) request. Plan ahead—this process
will take some time, as well as money for the cost of copies. Information for making a request can be found
on the FOIA website.

Samples of successful cover letters, letters of inquiry, proposals, and budgets can be found at the
Foundation Center's Grant
Space site.

Our proposal was rejected. Should we give up?

No. Many grant proposals are rejected several times before being funded. Review the comments the grant reviewers
made, address the project's weaknesses in future applications, and be sure to work closely with a program
officer on future applications.

You may also look for other sources of funding for your proposal, but be sure to rework your proposal to closely
follow the guidance of the new opportunity.

Our proposal was funded. How do we live up to our funder's expectations?

Write a thank you note to the funder (before depositing the check, if possible), and submit reports about your
project on time. Follow through with the activities you outlined in your proposal, and be sure to keep the
funder informed about any changes that you need to make when the project is in progress. Send event invitations
and other related products to the funder throughout the course of the project.

During the lifespan of the project, be sure to:

Submit grant deliverables and reports on time

Be responsive to requests

Always clarify grant requirements and expectations if you are unsure

Remember that you are building a relationship with the funder. This may be your first grant from a specific
funder, but you may be approaching them again in the future for continuation funds or a different project
entirely. Applicants want to establish a long-term relationship by building contacts, securing a firm
relationship, and showing that your organization is a good steward of their funds.

How can I learn more about preparing grant proposals?

There are several free online tutorials you can take, such as these from the Foundation Center:

The Rural Health Information Hub is supported by the Health Resources
and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS)
under Grant Number U56RH05539 (Rural Assistance Center for Federal Office of Rural Health
Policy Cooperative Agreement). Any information, content, or conclusions on this website are
those of the authors and should not be construed as the official position or policy of, nor
should any endorsements be inferred by HRSA, HHS or the U.S. Government.